Laminotomy vs Laminectomy: Procedures for Curing Spinal Conditions

Laminotomy and laminectomy are both surgical procedures that can treat spinal conditions (namely spinal stenosis). Although these procedures both involve the lamina of the vertebrae, each is a unique treatment. 

Here, we’ll discuss the key differences between laminotomy and laminectomy, including when each procedure may be implemented and how to determine the right treatment for your needs. 

Laminotomy and Laminectomy: What’s The Difference?

Laminotomy and laminectomy are both considered spinal decompression surgeries. Both affect the lamina of the spine, which creates the roof of the spinal canal. The procedure is intended to increase the amount of space around the spinal cord to relieve compression and the symptoms that it causes.  

In laminotomy or laminectomy, your surgeon will make an incision along the back and remove some, most, or all of the lamina. If required, your surgeon may also perform a discectomy (removal of a spinal disc) and/or foraminotomy (enlargement of the passageway for a spinal nerve root). 

Spinal fusion is another common step in laminotomy and laminectomy to restore spinal stability. However, spinal implants like the TOPS System can be used as a safer, more effective alternative to spinal fusion in spinal decompression surgery. We’ll discuss this in greater detail below. 

Understanding Laminectomy

During a laminectomy, a surgeon takes out most or all of the lamina. This is considered major surgery and typically isn’t performed unless more conservative treatment options have failed. Laminectomy may be performed on the cervical, lumbar, sacral, or thoracic spine. 

Understanding Laminotomy 

In laminotomy, the surgeon takes out a small piece of the lamina. This differentiates it from laminectomy, during which most of the lamina is removed.

The goal of laminotomy is generally to remove just enough of the lamina to lessen the pressure on a specific part of the spine. Like laminectomy, laminotomy can be done on the cervical, lumbar, sacral, or thoracic spine. 

Laminotomy may involve one or multiple vertebrae. When it affects just one vertebra it’s referred to as single-level laminotomy; when it affects multiple vertebrae, it’s known as multilevel laminotomy. 

Reasons to Undergo Laminotomy vs. Laminectomy

Since laminotomy and laminectomy are types of spinal decompression surgery, both are generally recommended for patients with spinal cord compression from conditions like spinal stenosis, herniated disc, and bone spurs.

When spinal cord compression leads to myelopathy or impaired spinal cord function, laminotomy or laminectomy may be suggested. Symptoms of myelopathy include:

  • Weakness, tingling, or numbness
  • Difficulty walking
  • Poor balance
  • Trouble with fine motor skills
  • Lost urinary or bowel control
  • Pain in the lower back, arm, leg, or neck

Laminotomy involves a smaller incision and causes less damage to surrounding tissues than a laminectomy. So, surgeons generally try to perform laminotomy over laminectomy whenever possible. However, if the degree of spinal compression is too severe to be resolved with laminotomy, laminectomy may be required. 

Alternatives to Laminotomy and Laminectomy

Patients struggling with symptoms of myelopathy will typically undergo non-surgical treatments before spinal surgery is considered. These may include:

  • A healthy lifestyle

An exercise regimen and a balanced diet can help patients manage spinal discomfort.

  • Physical therapy

Physical therapy may also be suggested to reduce pain and improve balance within the body. A physical therapist can give patients exercises to release pressure in the spine without surgery. 

  • Medications 

Medications may be recommended for patients with severe pain from spinal compression. This can help with day-to-day pain management, but may not be a long-term solution. 

When non-surgical treatment methods fail to offer relief from symptoms of spinal compression, doctors often recommend spinal decompression surgery so that patients can attain a higher quality of life.  

Conditions That May Require Laminotomy or Laminectomy

As aforementioned, some of the most common procedures that lead to spinal decompression surgery include spinal stenosis, herniated spinal disc, and bone spurs. 

  • Spinal stenosis

Spinal stenosis is a condition that occurs when the spaces in the spine narrow. This can place added stress on the spinal nerves, leading to symptoms like numbness, tingling, muscle weakness, pain, and sciatica.

Laminotomy or laminectomy can help treat spinal stenosis by opening up space in the spine. 

  • Herniated spinal disc

A herniated disc (or slipped disc) develops when the soft interior of one of the spinal discs presses out through a crack in the disc’s tough exterior. The protruding center of the disc can press on nearby nerves, leading to pain, weakness, and numbness.

Spinal decompression surgery can release the pressure on the affected nerves for symptom relief. 

  • Bone spurs

Bone spurs are bony lumps that form off of an existing bone. Osteoarthritis is the most prevalent cause of bone spurs, and symptoms of them include pain, stiffness, weakness, numbness, tingling, and muscle spasms.

During spinal decompression surgery, bone spurs can be removed to relieve the added pressure on the spinal cord or nerves. 

Recovering from Laminotomy and Laminectomy

Since laminotomy is a moderately less involved procedure than laminectomy, it can have a faster recovery period. However, most patients need several weeks (often between four and six weeks) to fully recover from laminotomy or laminectomy. 

Laminotomy and laminectomy can both be outpatient procedures, meaning that you can return home on the same day as the surgery. That said, if spinal fusion is performed along with spinal decompression surgery, patients may need to remain in the hospital for up to four days. 

After you return home from laminotomy or laminectomy, get plenty of rest. In the first several days after your spinal procedure, ask for help from loved ones for chores around the house and other essentials, like grocery shopping.

You should also take a break from work for a few weeks following spinal decompression surgery. Taking time off now will ultimately speed up your recovery and ensure optimal results from the procedure. Your doctor will also likely recommend physical therapy to support your recovery process 

Spinal Fusion in Laminotomy and Laminectomy

Spinal fusion is commonly performed with laminotomy or laminectomy. In spinal fusion, the doctor permanently connects, or fuses, two vertebrae. Eventually, the vertebrae will form one bone, which can counter instability. 

Although spinal fusion is commonly performed, it can make either laminotomy or laminectomy a more traumatic procedure. Spinal fusion slows down the recovery process and can limit the patient’s range of motion in the spine. 

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Spinal Implants: An Alternative to Spinal Fusion in Laminotomy and Laminectomy

Spinal implants like the Premia Spine TOPS System can reduce the trauma and recovery period associated with laminotomy and laminectomy. The TOPS system is implanted into the treatment area after spinal decompression surgery to provide stability while preserving the patient’s range of motion in the spine. 

While spinal fusion prevents motion in the affected vertebrae, TOPS implants move with the body. It stabilizes the spine so that the patient can move comfortably. With the TOPS device, it’s possible to secure the spine without compromising the patient’s flexibility. 

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Bonnie explains why TOPS surgery was the right decision for her

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Scott speaks about going to surgery

Improved Recovery With The TOPS System

A TOPS System Implant allows for an easier recovery period after laminotomy or laminectomy. Compared to conventional spinal fusions, surgery with the TOPS device allows patients to return to their normal activities faster.   

If you’re suffering from debilitating pain due to spinal compression, laminotomy or laminectomy may be your path to a more comfortable, pain-free life. The TOPS spinal implant can make either of these spinal decompression procedures less traumatic. For more information, reach out to Premia Spine